RESEARCH SUMMARY

Summary of: FULL PAPER DETAILS

Factors influencing the shade

1Lecturer, Department of Applied Dental Sciences,

Jordan University of Science and Technology (JUST)

Faculty of Applied Medical Sciences, Jordan; 2*Clinical
Senior Lecturer in Restorative Dentistry/Honorary

matching performance of dentists Consultant in Restorative Dentistry, The Dental School

and Hospital, Park Place, Dundee, DD1 4HN
*Correspondence to: Dr R. G. Chadwick

and dental technicians when Email: r.g.chadwick@dundee.ac.uk;

Tel/Fax: +44 (0)1382 635 984
Online article number E23

using two different shade guides Refereed Paper - accepted 7 April 2011
DOI: 10.1038/sj.bdj.2011.1006
© British Dental Journal 2011; 211: E23

M. Alomari1 and R. G. Chadwick2

VERIFIABLE CPD PAPER

Introduction In recent years increased patient aesthetic expectations have brought about closer scrutiny of shade taking
and communication processes with the aim of increasing the chances of success of obtaining good indirect restoration
appearance. When shade matching, the most popular approach is to match the shade of the natural dentition using
a shade guide to specify the shade of the final restoration before fabrication. A recent alternative approach is to also
specify the shade of the tooth preparation to facilitate its replication in the die upon which the restoration will be made.
Objective To assess (1) the colour vision ability of a sample of dentists and dental technicians and correlate this to their
shade matching performance in a simulated clinical situation, and (2) the accuracy and reproducibility of shade matches
using two shade guides. Design In vitro study. Method Consenting dentists and dental technicians within Dundee Dental
School and Hospital undertook a Farnsworth-Munsell 100 (FM-100) Hue test and matched (on two separate occasions)
the shades of six prepared extracted teeth, containing either a veneer or crown preparation, using both the IPS Natural Die
Material shade guide (Ivoclar Vivadent) (IPS) and the Vitapan Classical shade guide (VITA Zahnfabrik) (VC). Results Eighteen
dental technicians (16 males and 2 females) and 40 dentists (21 males and 19 females) completed the study. The raw
data revealed that many subjects were inconsistent in their approach to shade matching. The IPS guide afforded greater
reproducibility. No significant effects (p >0.05) of subject gender and age upon overall shade matching performance were
demonstrated. Performance in the FM‑100 Hue test did not statistically affect (p >0.05) the outcome of matching using the
guides. Conclusions Within the limitations of this study, (a) the FM‑100 Hue test was not a good predictor of dental shade
matching performance, and (b) both guides performed well in the areas of shade they covered, with the Vita Classical guide
matching well shades of natural unstained teeth and the IPS guide matching more closely stained/discoloured preparations.

EDITOR'S SUMMARY
With the renewed debate on the ethics of
cosmetic dentistry coming to the fore, it
is pertinent to view this paper as central
to the issue of clinical effectiveness and
technical competency.1 From a patient’s
perspective the match of a tooth-coloured
restoration to the existing and adjacent
tooth tissue is crucial in their assessment
of the success of the outcome.
This paper asks some fundamental
questions about our ability as clini-
cians to perceive colour matches and
shade assessment, the accuracy of shade
guides provided for transfer of informa-
tion and reproducibility from surgery
to dental laboratory and the hue of the
underlying tooth preparation. One might
be forgiven for wondering whether, with
so many variables, it is ever possible
to arrive at a satisfactory, aesthetically
pleasing result. The fact that it clearly
is, is a testament to the successful col-
laborative nature of the dental team;
materials researchers, manufacturers,
practitioners and technicians.
Aside from the technical issues the
paper once again draws our attention
to the often discussed but frequently
poorly observed need for good co-oper-
ation between dentist and technician.
Although unquestionably now members
of the dental team since their inclusion
as GDC registrants in the role of Den-
tal Care Professionals, technicians have
historically often been at a physical
distance from the surgery and as such
have suffered greater isolation than
other team members who have direct
patient contact. This has often lead to
breakdowns in communication, lack of
understanding and consequent blame
and recrimination where restorations or
appliances have been found wanting.
Mutual appreciation of skills, knowl-
edge and experience in a professional’s
given field is not just essential in the
provision of maximum patient care it
is fundamental to good practice and to
continuing education and development.
Greater understanding of the processes
both chairside and at the bench enable
us to make the very best of the art and
science of dentistry.
The full paper can be accessed from
the BDJ website (www.bdj.co.uk), under
‘Research’ in the table of contents for
Volume 211 issue 11.
Stephen Hancocks
Editor-in-Chief
1 Hancocks S. The ethics of cosmetics. Br Dent J
2011; 211: 501.
DOI: 10.1038/sj.bdj.2011.1030

528 BRITISH DENTAL JOURNAL VOLUME 211 NO. 11 DEC 10 2011

© 2011 Macmillan Publishers Limited. All rights reserved.

TO ACCESS THE BDJ WEBSITE TO READ THE FULL PAPER:
• BDA Members should go to www.bda.org.
• Click the ‘login’ button on the right-hand side and enter your BDA login details.
• Once you have logged in click the ‘BDJ’ tab to transfer to the BDJ website with full access.
IF YOUR LOGIN DETAILS DO NOT WORK:
• Get a password reminder: go to www.bda.org, click the login button on the right-hand side
and then click the forgotten password link.
• Use a recommended browser: we recommend Microsoft Internet Explorer or Mozilla Firefox.
• Ensure that the security settings on your browser are set to recommended levels.
IF YOU HAVE NOT YET SIGNED UP TO USE THE BDA WEBSITE:
• Go to www.bda.org/getstarted for information on how to start using the BDA website.
COMMENTARY
This paper by Alomari and Chadwick
evaluated variables possibly associated
with shade matching quality: type of
shade guide, shade matching methods
(one shade or two shades selected), and
subjects’ gender, age, shade matching
experience and profession (dentists and
laboratory technicians). The utilised
colour-corrected light was of appropri-
ate colour temperature (5,500K), colour
rendering index (92) and illuminance at
shade matching area (approx. 1,400 lx),
while the neutral light grey card was
a correct choice to prevent eye fatigue.
Shade matching tests for individuals
that determined what is the best match
for each prepared tooth and shade
guide were also well planned, although
instrumental colour measurements
would certainly complement their find-
ings and the overall merit of the study.
The literature is fairly consistent
when it comes to the positive influence
of colour education. The same is true
for shade guides with better coverage
of tooth colour range and distribution.
This study reported that one shade guide
exhibited greater reproducibility and a
lower percentage of incorrect matches,
but it should be noted that it is reasona-
ble to expect this for a shade guide with
fewer tabs (and therefore fewer choices
and greater colour differences among
the tabs). As far as the influence of tab
arrangement is concerned, some stud-
ies reported that it influenced shade
matching performance, while others
had the opposite findings. This study
found the same percentage of exact
matches for A to D arrangement and
BRITISH DENTAL JOURNAL VOLUME 211 NO. 11 DEC 10 2011
value scale of Vita Classical, whereas
the percentage of close matches was
higher for value scale.
The literature is also equivocal
regarding some other potential shade
matching variables: a majority of stud-
ies reported that gender, age, experi-
ence and profession did not influence
shade matching quality, whereas shade
matching conditions and method did.
In this study, gender and age did not
influence shade matching results,
whereas experience and profession did.
Finally, the FM-100 Hue test is a
non-dental, conventional colour dis-
crimination test, and according to sev-
eral publications, its results correlate
to a certain extent with the findings
obtained using customised dental tests.
In general, there would be no harm if
both tests were used in dental colour
research.
It is interesting that the study design
corresponds in many aspects to the
new ISO Guidance on colour measure-
ment,1 published after the execution of
this experiment. Regardless of some
wanting design details, the authors
should be commended on their work in
this important and complex yet some-
times neglected area.
R. D. Paravina
Associate Professor, Department of
Restorative Dentistry and Biomaterials
Acting Director, Houston Center for
Biomaterials and Biomimetics (HCBB)
University of Texas School of Dentistry
at Houston, Houston, TX, USA
1. International Organisation for Standardisa-
tion. ISO/TR 28642 dentistry – guidance on
color measurement. Reference number ISO/TR
28642:2011(E). Geneva: International Organisa-
tion for Standardisation, 2011.
© 2011 Macmillan Publishers Limited. All rights reserved.
RESEARCH SUMMARY
IN BRIEF
• Explores a new approach to shade
communication for laboratory fabricated
RESEARCH
all-ceramic restorations.
• Establishes that the FM‑100 Hue test is
not a good predictor of shade matching
performance.
• Highlights the importance of experience in
shade guide use.
• Indicates that tooth colour matching
performance is not influenced by age
or gender.
AUTHOR QUESTIONS
AND ANSWERS
1. Why did you undertake this research?
In recent years heightened patient aes-
thetic expectations, together with the
availability of new porcelains, has
brought about a re-examination of tech-
niques for shade taking. In the authors’
experience the focus has been exclu-
sively on the shade of the final resto-
ration, with scant, if any, regard being
given to the underlying preparation. It
is, however, well accepted that where a
crown is exclusively made up of por-
celain, shine through of the underly-
ing tooth preparation can compromise
adversely the aesthetics. To address this
it has been suggested that the dentist
should also communicate the shade of
the underlying preparation to the dental
technician. If adopted this represents a
paradigm shift in procedure. This work
sought, therefore, to examine means of
achieving this together with factors that
could affect potentially the outcome.
2. What would you like to do next in this
area to follow on from this work?
This work indicates that communication
of the shade of the underlying prepara-
tion is both possible and reproducible.
It would be interesting to study the
opinions of all members of the dental
team, and the patients for whom all-
ceramic crowns have been provided, as
to whether the additional steps involved
produce tangible aesthetic benefits.
It would also be of interest to learn if
knowledge of one’s colour matching
ability can assist in improving shade
taking performance.
529